Evaluation Study of a Collaborative Stepped-Care and Productive Ageing Model for Elderly Mental Wellness in Hong Kong
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- The University of Hong Kong
- Enrollment
- 5,239
- Locations
- 43
- Primary Endpoint
- Change from Baseline Depression at 12 months
Study Overview
Brief Summary
The Jockey Club Holistic Support Project for Elderly Mental Wellness (JC JoyAge) has developed and implemented a collaborative stepped care model for older persons at-risk of or with depression in four districts in Hong Kong since 2015 (Clinical Trials Identifier: NCT03593889). Results from JC JoyAge show that the collaborative stepped-care model is effective in improving older persons' mental wellness, and the specialised training and engagement of Peer Supporters are effective in building capacity in the community. The proposed impact extension programme lasts for four years (from 2020 to 2023), and the overall goal is to expand the JC JoyAge model to all 18 districts in Hong Kong, to provide integrated and evidence-based mental health services to older adults with subclinical depressive symptoms, with the hope of model adoption in regular service upon project completion.
Detailed Description
This four-year extension project includes three main elements: 1) Trainings, including different programmes for social services staff, Mental Wellness Ambassadors, and Peer Supporters; 2) Implementation of JoyAge service model: standardized collaborative stepped-care and Peer Support programmes for prevention and early intervention of depression in older adults; and 3) Public awareness campaign: coordinated programmes to increase mental health literacy and raise public awareness.
Specific goals of the programmes through the above three elements include:
- To implement JC JoyAge clinical protocol and guidelines to coordinate care among community mental health and aged care services centres for elderly mental wellness in 18 districts;
- To engage vulnerable and at-risk older adults in the community through productive ageing activities and mental wellbeing self-management training;
- To enhance the capacity of social service staff in handling elderly depression through specialized and infusion training and knowledge exchange;
- To raise public awareness and elderly mental health literacy among family members, neighbours, community stakeholders, and the general public to encourage early detection/help-seeking on depressive risk of older adults; and
- To establish evidence of the effectiveness and cost-effectiveness of JC JoyAge Phase II model.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Prevention
- Masking
- None
Eligibility Criteria
- Ages
- 60 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •age 60 years or above; and
- •have depressive symptoms of mild level or above; and
- •able to give informed consent to participate
Exclusion Criteria
- •known history of autism, intellectual disability, schizophrenia-spectrum disorder, bipolar disorder, Parkinson's disease, or dementia; and
- •(temporary exclusion criteria) imminent suicidal risk; and
- •difficulty in communication
Outcomes
Primary Outcomes
Change from Baseline Depression at 12 months
Time Frame: Baseline and 12-month follow-up
Depression will be measured by the Patient Health Questionnaire (PHQ-9), a 9-item instrument that incorporates depression diagnostic criteria with other leading major depressive symptoms, and rates the frequency of the symptoms that factor into the scoring severity index. PHQ-9 total score ranges from 0 to 27, higher scores indicate higher levels of depression. Change scores of depression will be calculated by subtract the baseline PHQ-9 score from the follow-up PHQ-9 score, and negative results indicates reduction in depression.
Change from Baseline Self-harm Risk at 12 months
Time Frame: Baseline and 12-month follow-up
Self-harm risk will be assessed using eight items adapted from the Self-Harm Inventory, providing an overall assessment based on total score and clinical judgement. Social service staff assess participants' risk of self-harm (yes or no answers to 10 items) and harm to others (yes or no answers to 4 items). An overall evaluation of suicidal risk score ranges from 0 (No) to 3 (High). The overall evaluation score will be used. Change scores of self-harm risk will be calculated by subtract the baseline overall risk score from the follow-up risk score, and negative results indicates reduction in self-harm risk.
Change from Baseline Anxiety at 12 months
Time Frame: Baseline and 12-month follow-up
Anxiety will be measured by the Generalized Anxiety Disorder scale (GAD-7), a 7-item scale in which responses to each item are rated on a 4-point Likert scale ranging from 0 to 3. The total score will be used, ranging from 0 to 21. Higher scores indicate higher levels of anxiety symptoms. Change scores of anxiety will be calculated by subtract the baseline GAD-7 score from the follow-up GAD-7 score, and negative results indicates reduction in anxiety.
Change from Baseline Service Usage at 12 months
Time Frame: Baseline and 12-month follow-up
Client Service Receipt Inventory (CSRI) will be used to collect the current types and level of social services which comprise the care package of each participant, and a locally adapted short version would be developed for this purpose. Participants report frequency of usage of different services in the past month when filling the questionnaire, higher frequency indicates more usage of that particular service.
Change from Baseline Loneliness at 12 months
Time Frame: Baseline and 12-month follow-up
Loneliness will be measured by the UCLA loneliness scale (UCLA-3), a 3-item self-report scale with each item evaluated with scores ranging from 0 (never) to 3 (often). The total score will be used, ranging from 0 to 9. Higher scores indicate greater loneliness. Change scores of loneliness will be calculated by subtract the baseline UCLA-3 score from the follow-up UCLA-3 score, and negative results indicates reduction in loneliness.
Secondary Outcomes
- Change from Baseline Cognition at 12 months(Baseline and 12-month follow-up)
- Change from Baseline Daily Activities at 12 months(Baseline and 12-month follow-up)
- Change from Baseline Social Network at 12 months(Baseline and 12-month follow-up)
- Change from Baseline Health-related Quality of Life at 12 months(Baseline and 12-month follow-up)
- Change from Baseline Self-rated Health at 12 months(Baseline and 12-month follow-up)
Investigators
Professor Terry Y.S. Lum
Professor
The University of Hong Kong